NGS Completes Pre-Payment Review of Group 2 Support Surfaces

• By Laurie Watanabe
• Oct 02, 2010

National Government Services (NGS), the Jurisdiction B DME MAC, has completed a widespread pre-payment targeted medical review for Group 2 pressure-reducing support surfaces.

The items included in the review were HCPCS coded E0277.

The review examined 101 claims from 61 suppliers. Of those 101 claims, 11 were allowed as billed.

But 34 claims were denied because no documentation was received, while nine more claims were denied for missing or invalid detailed written orders.

The other 47 claims were denied for at least one of the following reasons, according to NGS:

• Documentation showed that the support surface was being used due to a medical condition such as back pain or arthritis, rather than as treatment of a pressure ulcer. Said NGS' statement: "The Local Coverage Determination (LCD) for 'pressure-reducing support surfaces Group 2' specifies that these items are covered only for patients with pressure ulcers on their trunk or pelvis."
• For patients who did have stage II pressure ulcers, medical records lacked the required documentation of a comprehensive ulcer treatment program during the month prior to providing the support surface (E0277).
• No documentation was provided to support the client’s continued medical necessity for E0277.
• Wound documentation with measurements was insufficient or missing entirely. "On claims for subsequent-month rentals, suppliers were expected to provide documentation regarding the most recent wound assessment prior to the date of service on the claim being reviewed," the NGS statement said.
• No proof of delivery of the support surface was provided.